下血を来したサイトメガロウイルス小腸炎の1例

Cytomegalovirus Enteritis with Hematochezia, Report of a Case

要旨●患者は70歳代，女性．1週間続いた腹痛，嘔吐の後に下血が出現し，当院を受診した．腹部CT検査で主に骨盤内小腸を中心とした壁肥厚と，血液検査で炎症反応上昇を認めた．絶食，補液，抗菌薬投与にて加療を開始し，一時的に症状の改善を認めた．ダブルバルーン小腸内視鏡検査では空腸に不整形地図状潰瘍を認めた．潰瘍部位の生検組織には封入体像を認め，免疫染色からサイトメガロウイルス小腸炎と診断した．遷延する腹部症状に対してバルガンシクロビル投与を行い著明に改善した．本症例は消化管出血を来す小腸疾患の鑑別に重要と考え報告する．

　After having abdominal pain and nausea for 1 week, a female patient in her 70s visited our hospital with the chief complaint of hematochezia. Abdominal computed tomography images revealed wall thickness of the small bowel, and laboratory finding demonstrated remarkable inflammatory change. After admission, her symptoms gradually improved without any specific treatment. Double-balloon enteroscopy revealed distorted ulcers in the jejunum. The diagnosis of CMV（cytomegalovirus）enteritis was made on the basis of the biopsy specimen obtained from the ulcers. Her sustained abdominal discomfort was completely resolved after treatment with valganciclovir. Therefore, CMV enteritis should be considered for the differential diagnoses of intestinal bleeding.